Comparison between high and low levels thoracic sympathectomy for the treatment of palmar and axillary primary hyperhidrosis: systematic review and meta-analysis

FELISBERTO JÚNIOR, GILMAR; RUBIRA, CLÁUDIO JOSÉ; BERUMUDES, JOÃO PAULO SANCHES; BUENO DA-SILVEIRA-JÚNIOR, SALUM

doi:10.1590/0100-69912016006009

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Revista do Colégio Brasileiro de Cirurgiões

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Review Article • Rev. Col. Bras. Cir. 43 (6) • Nov-Dec 2016 • https://doi.org/10.1590/0100-69912016006009 copy

Comparison between high and low levels thoracic sympathectomy for the treatment of palmar and axillary primary hyperhidrosis: systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Primary hyperhidrosis (PH) is a condition that has a great impact on affected individuals' quality of life, regardless of its location. Its surgical treatment is done through thoracic sympathectomy performed by videothoracoscopy. Standardization of the technique includes section of the sympathetic trunk at different levels, according to the site of symptoms. The aim of this review is to evaluate the efficacy of thoracic sympathectomy through a systematic literature review comparing sympathectomy at different levels of the sympathetic chain.

Keywords:
Hyperhidrosis. Sympathectomy. Thoracic Surgery; Video-Assisted. Meta-Analysis

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[1] Mailing address: Gilmar Felisberto Junior E-mail: crtorax@gmail.com / gfj38@uol.com.br

Author/Year	High levels	Low levels	Levels compared	Location of symptoms
Baumgartner, 2007	61	60	T2/T3	Palmar
Ishy, 2010	20	20	T3/T4	Palmar
Li, 2008	115	117	T2-4/T3	Palmar
Liu, 2009	68	73	T3/T4	Palmar
Munia, 2007	32	30	T3-4/T4	Axillary
Munia, 2008	31	33	T3-4/T4	Axillary
Vicidomi, 2011	50	50	T2-4/T3	Palmar
Yang, 2009	78	85	T3/T4	Palmar
Yasbek, 2009	30	30	T2/T3	Palmar
Yuncu, 2013	17	43	T3-4/T4	Axillary

	Higher level			Lower level		Risk Ratio
Study or Subgroup	Events	Total	Events	Total	Weight	M-H, Fixed 95% CI
* Symptom control for palmar PH.
Baumgartner, 2001	37	41	38	40	21.4%	0.95 [0.84, 1.07]
Li, 2008	89	115	96	117	53.0%	0.94 [0.83, 1.07]
Liu, 2009	15	62	40	69	0.0%	0.42 [0.26. 0.68]
Vicidomini, 2011	45	50	46	50	25.6%	0.98 [0.86, 1.11]
Total (95% CI)		206		207	100.0%	0.95 [0.88, 1.03]
Total events	171		180
** Compensatory Sweating for palmar PH.
Baumgartner, 2001	16	50	9	46	26.2%	1.64 [0.80, 3.33]
Ishi, 2010	1	15	1	20	2.4%	1.33 [0.09, 19.64]
Li, 2008	18	115	13	117	36.0%	1.41 [0.72, 2.74]
Liu, 2009	9	62	2	69	5.3%	5.01 [1.12, 22.29]
Vicidomini, 2011	5	50	1	50	2.8%	5.00 [0.61, 41.28]
Yang, 2009	18	78	6	85	16.1%	3.27 [1.37, 7.81]
Yasbek, 2009	13	30	4	30	11.2%	3.25 [1.20, 8,83]
Total (95% CI)		400			100.0%	2.26 [1.57, 3.25]
Total events	80		36	417
*** Symptom Control for axillary PH.
Munia, 2007	28	32	29	30	58.2%	0.91 [0.78, 1.05]
Yuncu, 2013	11	17	38	43	41.8%	0.73 [0.51, 1.06]
Total (95% CI)		49		73	100.0%	0.83 [0.70, 0.99]
Total events	39		67
**** Compensatory sweating for axillary PH.
Munia, 2007	11	32	2	30	68.1%	5.16 [1.24, 21.37]
Munia, 2008	11	31	1	33	31.9%	11.71 [1.60, 85.45]
Yuncu, 2013	17	17	34	43	0.0%	1.24 [1.04, 1.48]
Total (95% CI)		63		63	100.0%	7.25 [2.30, 22.84]
Total events	22		3